Our Previous Samples

CARE OF A PATIENT WITH BREAST CANCER Sample Paper

Breast cancer is the most common cancer in women and the leading cause of death. Thus, the burden of this disease is overwhelming. Identification of women at risk for breast cancer and prompt evaluation of these women is important to diagnose and treat this condition early. Physical assessment proves to be an important tool in the diagnosis of breast cancer. The management of breast cancer is a holistic approach involving the nurse, the doctor, the oncologist and the surgeon. The nurse plays a major role in the entire treatment process of a cancer patient

Ms. Williams has several factors exposing her to breast cancer. She had her first pregnancy at an age above 30. Ms. Williams is taking birth control pills. Oral contraceptives are known to increase the risk of developing breast cancer. She also has a family history of breast cancer- a maternal aunt who had breast cancer. She is taking an over-the-counter antihistamine. In a study by Bens (2020) in the British Journal of Cancer, the use of antihistamines has been associated with breast tumor proliferation and thus the development of cancerous growths.

A detailed physical assessment of Ms. Williams has to be done for diagnostic purposes. The nurse should check the color of the skin of the breast and the nipple and note any discharge from the nipple. The discharge in breast cancer is mostly bloody. She should observe for changes in the size of the affected breast. Redness and warmth of the breast area would denote an inflammatory process. After palpation of the breast; the nurse should denote the quadrant in which the lump is, determine its size and shape (regular or irregular). The nurse should also try to move it to feel if it is attached to the chest or the skin. Palpation also reveals tenderness. Normally lumps are painless. The nurse should also assess the respiratory and cardiovascular systems state as there could be metastatic spread into the lungs and heart in the event of breast cancer. Palpation of the supraclavicular nodes for tenderness and enlargement should be done.

The management of Ms. Williams shall require a team approach by the health care providers. The doctor is necessary for the diagnosis of the disease and referral to an oncologist. The oncologist, after his assessment, determines the best treatment method. Tumors with regular edges can be removed by surgical excision. The surgeon and his teams prepare for the surgery and advice on post-operative care.  The nurse carries out the pre-operative and post-operative care required by this patient. The psycho-oncologist is very important in arraying anxiety and teaching life coping mechanisms. Sometimes, radiation might be the best option and the radiological team may need to be informed about Ms. Williams’s case.

Breast cancer can cause anxiety, fear and worry. The nurse should explain to Ms. Williams that a breast lump is not definitive that she has cancer. It could also be caused by local inflammation and blockage of the ducts. The nurse should reassure her. The nurse should teach Ms. Williams the disease process and how to cope effectively. The nurse should advise her to go for mammography.

As seen above, the diagnoses and management of breast cancer require a multidisciplinary team. Evaluation of risk factors should be taken into account during the care of this patient. Patient education and also public awareness are important preventive measures.

References

• Bens, A., Dehlendorff, C., Friis, S., Cronin-Fenton, D., Jensen, M. B., Ejlertsen, B., … & Mellemkjær, L. (2020). The role of H1 antihistamines in contralateral breast cancer: a Danish nationwide cohort study. British Journal of Cancer, 122(7), 1102-1108.
• https://www.nature.com/articles/s41416-020-0747-4
• Engmann, N. J., Golmakani, M. K., Miglioretti, D. L., Sprague, B. L., & Kerlikowske, K. (2017). Population-attributable risk proportion of clinical risk factors for breast cancer. JAMA oncology, 3(9), 1228-1236.
  https://jamanetwork.com/journals/jamaoncology/article-abstract/2599991
• Zardavas, D., Irrthum, A., Swanton, C., & Piccart, M. (2015). Clinical management of breast cancer heterogeneity. Nature reviews Clinical oncology, 12(7), 381.
• https://www.nature.com/articles/nrclinonc.2015.73.pdf?origin=ppub

Carolyn Cross V2VE Case Study SOAP Note and Differential Diagnoses for iHuman Case

Carolyn Cross V2VE Case Study SOAP Note and Differential Diagnoses for iHuman Case

Name: Carolyn Cross

Age: 41 years

Sex: F

Height: 5? 3?

Weight: 155 pounds (BMI 27.5)

Temperature: 98.4 F (oral) Pulse: 76 bpm – regular

Blood pressure: 134/74 mmHg122/72 upon standing

Respiratory rate: 16 bpm SpO2: 98% on room air Carolyn Cross

Chief complaint: Well-woman evaluation SOAP Note and Differential Diagnoses for iHuman Case.

Use this week’s iHuman case titled “Carolyn Cross V2VE” and create a SOAP note with a treatment plan (located at the bottom of the SOAP note.

Provide a subjective, objective, assessment, and plan (SOAP) note on this patient and your treatment plan using the SOAP note template provided Carolyn Cross V2VE Case Study SOAP Note and Differential Diagnoses for iHuman Case. Remember to keep the patient’s identity private; use the minimal amount of information possible to get the idea across.

Provide a reference for your treatment plan (in APA format). The reference may come from a journal, a book, etc. Cite all sources using APA format.

Include three differential diagnoses and support your diagnoses with supporting literature.

Skin: Warm, dry

Ms. Cross is a healthy 41-year-old G2P2 Hispanic-American female who presents for a well-woman examination. She has no active medical complaints, but is concerned about her risk of breast cancer as both her mother (age 63) and maternal first cousin (age 44) have been recently diagnosed with intraductal breast cancer.

Additional risk factors include menarche age 10.5; first pregnancy age 33; she breast fed each of her two infants for only four months each. The patient, reports a normal baseline mammogram at age 40, (report not available) and a history of fibrocystic breast disease. She is overweight (BMI 27.5) with a FH of hypertension, hyperlipidemia (father) and type 2 diabetes (mother).

She is concerned about her risk for breast cancer and does this fact increase her risk of breast cancer, her mother at 63 years old and first cousin 44 year old was recently diagnosed with breast cancer. She performs self-breast examines, no lumps or bumps or discharged noted by patient. She reports breast tenderness around her menstrual cycle.

Denies any health problems past or present. Immunizations are up to date. She gardens and does house work for exercise Carolyn Cross V2VE Case Study SOAP Note and Differential Diagnoses for iHuman Case. She reports later she takes vitamin E for fibro cystic breast disease, she had a mammogram 18 months ago.

Father has hyperlipidemia and HTN and mother is a type 2 DM and just diagnosed at 63 with breast cancer. Pt has a glass of wine every night with supper her diet is traditional Hispanic diet. Both breast is irregular lump and bump bilateral with slight diffuse tenderness. She has two boys and a husband no reported siblings

Labs

• Name
• Value
• Units
• Reference
• Range
• Cholesterol

239 mg/dL low risk <200, moderate 200-239, high >239 High-density lipoprotein (HDL) 45 mg/dL maj risk <40, neg risk >59 Low-density lipoprotein (LDL) 159 units/L low risk <130, moderate 130-159, high >159 Triglycerides 40 mg/dL (?) 35-135, (?) 40-16 Name Value Units Reference Range Glucose, 8 hour fasting 122 mg/dL <126 Name Value Units Reference Range Hemoglobin A1c 6.4 % normal 4-5.6, elevated risk 5.7-6.4, diabetes >6.7 Her papsmear was normal.

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.

LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Care of patient with HIV Example

Nurse’s Response to Ms. Michaels’ 1st Statement

Foremost, the nurse may need to inform the patient—Ms. Michaels of her status and educate her on what the disease entails. In other words, the nurse in charge may inform the patient that HIV is typically a virus that is contracted from a sexual debut while AIDS is a debilitating condition. Given this, the nurse may recommend counseling to the patient before suggesting the need for her start using antiretroviral drugs in the management and the minimization of the spread of the virus in the body. These therapies play a critical role in slowing down or stopping the progression of the condition (Komlenac & Hochleitner, 2019). If found positive, the relationship between sexual risks and substance abuse behaviors remains amongst the medical and sexual issues that should be addressed in a patient’s treatment plan.

Response to 2nd Statement

The nurse may need to inform the patient that there are no antibiotics for the management of the condition as they may not eradicate the virus. However, the consistent use of antiretroviral drugs may be effective in reducing disease progression. Secondly, the nurse should educate the patient on the fact that the contraction of HIV, if not properly managed, may result in the development of the AIDS virus. AIDS, which is the third stage of HIV infection, often develops when the human body contracts HIV.

The attempts driven towards the modification of the patient’s personal behavior such as changes in the patient’s sexual practices and drug use tends to be a challenging phenomenon; however, the use of this approach plays a vital role in the promotion of positive health and recovery measures. On the other hand, the integration of a family planning program remains one of the successful measures that may be used in the promotion of a positive health and recovery plan for the patient (Corburn & Riley, 2016). This, therefore, reveals that the integration of behavioral interventions may play a significant role in slowing and reducing the spread of HIV/AIDS.

Response to 3rd Statement

The nurse may equally inform the patient that the development and growth of the condition depends on her as the lack of proper use of the antiretroviral medicines may significantly weaken the immune system, making it prone to several diseases. In this regard, there is a need to construe treatment measures that may be used in addressing the established medical issue and sexual health problem. Given the nature of this problem, there is a need for the nurse to establish a proper mental health care approach directed towards addressing the patients’ medical state, efforts that detail the need to integrate appropriate counseling driven towards changing the behavior of the patient in question.

On the other hand, the integration, as well as implementation of a harm-reduction method, would play a vital role in the reduction of problematic use and abuse of substances as well as the problems that are related to the adverse sexual health that include HIV/AIDS (Komlenac & Hochleitner, 2019). These efforts would play a significant role in tooling the patient with the required skills needed in the management of their medical and sexual health issues. In this regard, the nurse plays a central role in educating the patient of her state and construing strategies that may be used in maintaining wellness.

Reference

• Corburn, J., & Riley, L. W. (2016). Slum Health?: From the Cell to the Street. Oakland, California: University of California Press. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=nlebk&AN=1132454&site=ehost-live
• Komlenac, N., & Hochleitner, M. (2019). Male Medical Students’ Gender-Role Conflict Is Associated With Their Discomfort With Dealing With Patients’ Sexual Health Issues. Journal of Sex Research (Vol. 56, pp. 930–936).

Case 1 Discussion: Allied health program

Case 1 Discussion: Allied health program

Case 1. Discussion

Beth is a recent graduate of an allied health program at the local community college. While in school, she had taken a course from a professor who she really admired and liked. In her first job out of school as a registration clerk at the hospital’s clinic, she happened to be assigned the professor to register as an outpatient for radiation therapy for a recently diagnosed cancer treatment. The two chatted as Beth input the professor’s information into the hospital’s EHR system.

They talked about the course and how much Beth liked the course and the professor as a teacher. Beth thought about the professor all day and felt terrible to learn the professor was being treated for cancer. She knew many of her classmates also liked the professor, so after work she decided to contact her friends about the professor and suggest they send the professor a card. Beth shared the professor’s home address.

Case 2.

Jan Geisler is the HIM director at Hillside Medical Center. The administration at Hillside has just approved the budget which includes a new electronic health record. They assign Jan as the project manager and give her the task of reviewing and selecting the company (vendor) with the EHR that best suits the hospital’s needs. Jan immediately thinks of her college roommate Ana. Ana also majored in HIM and now works for a large EHR vendor in California.

Jan sends a quick email to Ana to catch up and asks about her company’s EHR system. Ana responds immediately with updated pictures of her family and some general information about the EHR her company sells. Ana offers for her company to fly Jan to California so she can see the system and have a live demonstration. As an added bonus, Ana cannot wait to see her friend, take her to dinner and catch up.

Jan goes to California and enjoys her time with Ana, but she is a little disappointed with the EHR system. She just doesn’t think it will meet the needs of her hospital. Jan has a meeting with the chief information officer today and is expected to present her recommendations. She feels obligated to recommend Ana’s company, but she also has major concerns about their product.

1. What ethical issues can be found in Jan’s investigation of EHRs? (NOTE: In the textbook, there is a typo. It says Ana instead of Jan)
2. Was it a conflict of interest for Jan to do business with her personal friend Ana?
3. Using the ethical decision-making model found in this chapter, analyze the scenario and recommend a decision.

ORDER NOW FOR ORIGINAL, ORDER THROUGH BOUTESSAY

Instructions for Case 1 Discussion: Allied health program

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part, and you can expect your grade to suffer accordingly.

Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in, and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12-point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting a hard copy, be sure to use white paper and print it out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

• Initial responses to the DQ should address all components of the questions asked, including a minimum of one scholarly source, and be at least 250 words.
• Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
• One or two-sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
• I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

• Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
• In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
• Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
• Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

APA Format and Writing Quality

• Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud, for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
• Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
  I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

• I discourage the overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
• As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
• It is best to paraphrase content and cite your source.

LopesWrite Policy

• For assignments that need to be submitted to LopesWrite, please be sure you have received your report, and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
• Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
• Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
• Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

• The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies.
• Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
• If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
• I do not accept assignments that are two or more weeks late unless we have worked out an extension.
• As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:

• Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
• Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

 Also Read:

DNP835 All Modules Discussions

Low Back Pain Case Study

Dependent Personality Disorder (DPD)

SOCW 6111 Discussions Assessment Tools

HCA 459 Week 4 Discussion Question 2

CASE STUDY 1 5-Year Old Boy Whose Parents are Opposed to Vaccines

CASE STUDY 1 5-Year Old Boy Whose Parents are Opposed to Vaccines

The parents of a 5-year-old boy have accompanied their son for his required physical examination before starting kindergarten. His parents are opposed to him receiving any vaccines.

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Week 11: The Ethics Behind Assessment

Consider the following scenarios:

• You are a nurse at a large county hospital. One of your patients is leaning toward selecting a certain radical treatment for cancer, to which the family is in opposition. The family is concerned about making the correct decision and asks for your advice.
• The state of Oregon has passed a “Death with Dignity” act that allows for euthanasia in certain situations. One of your patients suffering from terminal cancer is thinking of moving there to take advantage of this law and asks your opinion.

Throughout this course, you have explored a wide range of health assessments and abnormal examination findings. Although you have predominantly focused on the procedural aspects of health assessment, this week, you will focus on ethical considerations that should be taken into account when advising patients or their families.

This week, you will consider how evidence-based practice guidelines and ethical considerations factor into health assessments. You will also evaluate health assessment concepts related to sports physicals and well-child and well-woman examinations.

Learning Objectives for CASE STUDY 1 5-Year Old Boy Whose Parents are Opposed to Vaccines

Students will:

• Apply evidence-based practice guidelines to make an informed healthcare decision
• Apply ethical considerations to a health assessment response
• Apply concepts, theories, and principles relating to sports physicals and well-child and well-woman examinations
• Identify  concepts, theories, and principles related to advanced health assessment

Learning Resources

Required Readings (click to expand/reduce)

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

• Chapter 24, “Sports Participation Evaluation”In this chapter, the authors describe the process of a sports participation evaluation. The chapter also states the most common conditions encountered in a sports participation evaluation.
• Chapter 25, “Putting It All Together”In this chapter, the authors tie together the concepts introduced in previous chapters. In particular, the chapter has a strong emphasis on the patient-caregiver relationship.

Tingle, J. & Cribb, A. (2014). Nursing law and ethics (4th ed.). Chichester, UK: Wiley Blackwell. 

Furman , C. D., Earnshaw, L. A., Farrer, L. A. (2014). A case of inappropriate apolipoprotein E testing in Alzheimer’s disease due to lack of an informed consent discussion. American Journal of Alzheimer’s Disease & Other Dementias, 29(7), 590–595. doi:10.1177/1533317514525829.

Navarro-Illana, P., Aznar, J., & Díez-Domingo, J. (2014). Ethical considerations of universal vaccination against human papilloma virus. BMC Medical Ethics, 15(29). doi:10.1186/1472-6939-15-29. Retrieved from http://www.biomedcentral.com/1472-6939/15/29

Maron , B. J., Friedman, R. A., & Caplan, A. (2015). Ethics of preparticipation cardiovascular screening for athletes. Nature Reviews Cardiology, 12(6), 375–378. doi:10.1038/nrcardio.2015.21

May, K. H., Marshall, D. L., Burns, T. G., Popoli, D. M. & Polikandriotis, J. A. (2014). Pediatric sports specific return to play guidelines following concussion. The International Journal of Sports Physical Therapy, 9(2), 242–255. PMCID: PMC4004129. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4004129/

American Academy of Pediatrics. (2008). Recommendations for preventative pediatric health care (periodicity schedule). Retrieved from https://www.harmonyhpi.com/WCAssets/illinois/assets/IL_MedicaidProviderManual_PEM_AdultPHGsForProviders.pdf

This resource provides recommendations for preventative pediatric healthcare from infancy through adolescence. The periodicity schedule covers a variety of areas, from health history to measurements, developmental/behavioral screenings, physical exams, procedural screenings, and oral health.

Rourke, L., Leduc, D., & Rourke, J. (2017). Rourke Baby Record. Retrieved from http://rourkebabyrecord.ca/

This website provides information on the Rourke Baby Record (RBR). The RBR supplies guidelines on growth and nutrition, developmental surveillance, physical exam parameters, and immunizations for well-baby and child care.

Document: Final Exam Review (Word document)

Assignment 1: Lab Assignment: Ethical Concerns

As an advanced practice nurse, you will run into situations where a patient’s wishes about his or her health conflict with evidence, your own experience, or a family’s wishes. This may create an ethical dilemma. What do you do when these situations occur?

In this Lab Assignment, you will explore evidence-based practice guidelines and ethical considerations for specific scenarios.

To Prepare

Review the scenarios provided by your instructor for this week’s Assignment. Please see the “Course Announcements” section of the classroom for your scenarios.

• Based on the scenarios provided:
  • Select one scenario, and reflect on the material presented throughout this course.
  • What necessary information would need to be obtained about the patient through health assessments and diagnostic tests?
  • Consider how you would respond as an advanced practice nurse. Review evidence-based practice guidelines and ethical considerations applicable to the scenarios you selected.

The Lab Assignment

Write a detailed one-page narrative (not a formal paper) explaining the health assessment information required for a diagnosis of your selected patient (include the scenario number). Explain how you would respond to the scenario as an advanced practice nurse using evidence-based practice guidelines and applying ethical considerations. Justify your response using at least three different references from current evidence-based literature.

By Day 6 of Week 11

Submit your Assignment.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

• Please save your Assignment using the naming convention “WK11Assgn+last name+first initial.(extension)” as the name.
• Click the Week 11 Assignment Rubric to review the Grading Criteria for the Assignment.
• Click the Week 11 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK11Assgn+last name+first initial.(extension)” and click Open.
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
• Click on the Submit button to complete your submission.

Grading Criteria

To access your rubric:

Week 11 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 11 Assignment draft and review the originality report.

Submit Your Assignment by Day 6 of Week 11

To participate in this Assignment:

Week 11 Assignment

Assignment 2: Lab Assignment: Practice Assessment: Mental Health Examination

The Lab Assignment

Complete the following in Shadow Health:

• Mental Health (Practice)

Exam: Week 11 Final Exam

Photo Credit: Getty Images/iStockphoto

This exam is a test of your knowledge in preparation for your certification exam. No outside resources, including books, notes, websites, or any other type of resource, are to be used to complete this exam. You are expected to comply with Walden University’s Code of Conduct.

This exam will be on topics covered in weeks 7, 8, 9, 10, and 11. Prior to starting the exam, you should review all of your materials. This exam is timed with a limit of 2 hours for completion. When time is up, your exam will automatically submit.

By Day 7 of Week 11

Complete the Final Exam.

Submission and Grading Information

Submit Your Final Exam by Day 7 of Week 11.

To Complete this Exam:

Week 11 Exam

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Rubric Detail

Select Grid View or List View to change the rubric’s layout. CASE STUDY 1 5-Year Old Boy Whose Parents are Opposed to Vaccines

Grid View
List View

• Excellent
• Good
• Fair
• Poor

Write a detailed 1-page narrative (not a formal paper) addressing the following:

Explain the health assessment information required for a diagnosis of your selected patient (include the scenario number).

30 (30%) – 35 (35%)

• The response clearly, accurately, and thoroughly explains detailed health assessment information required to diagnose the selected patient, with correct scenario number included.

24 (24%) – 29 (29%)

• The response accurately explains health assessment information required to diagnose the selected patient, with correct scenario number included.

18 (18%) – 23 (23%)

• The response vaguely explains health assessment information required to diagnose the selected patient, with scenario number, correct or inaccurate, included.

0 (0%) – 17 (17%)

• The response lacks and/or inaccurately explains assessment information required to diagnose the selected patient, with scenario number inaccurate or missing.

Explain how you would respond to the scenario as an advanced practice nurse using evidence-based practice guidelines and applying ethical considerations. Justify your response using at least three different references from current evidence-based literature.

45 (45%) – 50 (50%)

• The response clearly, accurately, and thoroughly explains detailed evidence-based practice guidelines and ethical considerations applied by an advanced practice nurse in responding to the scenario, with clear, accurate, and thorough justification using three or more different references from current evidence-based literature.

39 (39%) – 44 (44%)

• The response accurately explains evidence-based practice guidelines and ethical considerations applied by an advanced practice nurse in responding to the scenario, with accurate justification using at least three different references from current evidence-based literature.

33 (33%) – 38 (38%)

• The response vaguely explains evidence-based practice guidelines and ethical considerations applied by an advanced practice nurse in responding to the scenario, with vague and/or inaccurate justification using two to three different references from current evidence-based literature.

0 (0%) – 32 (32%)

• The response inaccurately explains or lacks evidence-based practice guidelines and ethical considerations applied by an advanced practice nurse in responding to the scenario, with inaccurate or missing justification using two or fewer references from current evidence-based literature.

Written Expression and Formatting – Paragraph Development and Organization:

Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.

5 (5%) – 5 (5%) 

• Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

4 (4%) – 4 (4%)

• Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.

3 (3%) – 3 (3%)

• Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment are vague or off topic.

0 (0%) – 2 (2%)

• Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.
• No purpose statement, introduction, or conclusion were provided.

Written Expression and Formatting – English writing standards:

Correct grammar, mechanics, and proper punctuation

5 (5%) – 5 (5%)

• Uses correct grammar, spelling, and punctuation with no errors.

4 (4%) – 4 (4%)

• Contains a few (1 or 2) grammar, spelling, and punctuation errors.

3 (3%) – 3 (3%)

• Contains several (3 or 4) grammar, spelling, and punctuation errors.

0 (0%) – 2 (2%)

• Contains many (? 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list.

5 (5%) – 5 (5%)

• Uses correct APA format with no errors.

4 (4%) – 4 (4%)

• Contains a few (1 or 2) APA format errors.

3 (3%) – 3 (3%)

• Contains several (3 or 4) APA format errors.

0 (0%) – 2 (2%)

• Contains many (? 5) APA format errors.

Total Points: 100

NURS 6003 Module 3 | Part 3: Research Analysis

I have identified one topic of interest for further study. I have researched and identified one peer-reviewed research article focused on this topic and have analyzed this article.  The results of these efforts are shared below.

Directions: Complete Step 1 by using the table and subsequent space below identify and analyze the research article you have selected. Complete Step 2 by summarizing in 2-3 paragraphs the results of your analysis using the space identified.

Step 1: Research Analysis

Complete the table below

Topic of Interest:

Research Article: Include full citation in APA format, as well as link or search details (such as DOI)

Gibson, C., Goeman, D., & Pond, D. (2020). What is the role of the practice nurse in the care of people living with dementia, or cognitive impairment, and their support person(s)?: a systematic review. BMC Family Practice, 21(1). https://doi.org/10.1186/s12875-020-01177-y

Professional Practice Use:

One or more professional practice uses of the theories/concepts presented in the article

This article provides key information to assist the nursing staff in providing great care to dementia patients. The potential value of expanding the Nurse position to include dementia recognition and management has been recognized.  Nurses are well-positioned to give comprehensive dementia information and support, empowering people living with dementia to self-manage their health and live well with dementia.

Research Analysis Matrix

Add more rows if necessary

Strengths of the Research

Limitations of the Research

Relevancy to Topic of Interest

Notes

Large number of articles were reviewed to collect the data.

The article focuses on practice nurses.

The article demonstrates the necessity of helping dementia patients live a quality life.

As nursing practitioners, we can alleviate suffering and help dementia patients live better lives.

Electronic databases and Google Scholar were searched for review articles.

There were no specifications on the types of dementia and their specific management.

The issue of dementia and cognitive impairment is a growing concern with an aging population.

Nurses as primary providers need knowledge on how to take care of patients experiencing cognitive impairment with growth in the population of old people.

Articles spanning 19 years have been used to improve the reliability of the information.

Most of the articles analyzed do not give the causal relationship between aging and the development of dementia.

The article illustrates the importance of treating the elderly as a vulnerable population.

Elaborating the role nurses can play in picking and management of cognitive impairment has the ability to improve the quality of care for elderly patients.

The article applies evidence-based intervention, which improves its validity.

The authors assert the need for further research to understand dementia on a grand scale.

The article is relevant to the topic of interest since it also shows the limitations of the research.

Step 2: Summary of Analysis

Craft a summary (2-3 paragraph) below that includes the following:

•         Describe your approach to identifying and analyzing peer-reviewed research
•         Identify at least two strategies that you would use that you found to be effective in finding peer-reviewed research
•         Identify at least one resource you intend to use in the future to find peer-reviewed research

Identification and analysis of peer-reviewed research articles necessitate using an effective method and applying databases and search terms to locate relevant research sources. I started by going through the university library’s databases and publications in this situation. PubMed from the National Library of Medicine, CINHAL Comprehensive, and Web of Science were among them. I also concentrated on papers about Alzheimer’s disease and cognitive impairment. 

The last step was to narrow my research findings using key terms and words such as “Alzheimer’s and dementia.” After reading the abstract and full-text articles, I assessed the significance of the paper’s content. I also ensured that the publications I obtained were full-text articles to acquire all possible information, particularly the study’s limitations. The article was then assessed based on its relevance to the topic of interest. I also ensured that the articles were published within the last five years.

In research analysis, having successful strategies is critical. In this example, the aim was to have journal articles published by well-known and recognized institutions and researchers to increase their reputation and trustworthiness. Ensuring that the articles are listed in an online database like PubMed, overseen by the National Library of Medicine, was a vital element of the study. In the search, I also utilized keywords and concepts to find research publications and studies with relevant material on the topic of interest.

PubMed, particularly its online database, is a fantastic resource I plan to use to obtain peer-reviewed research study publications. This resource, managed by the National Library of Medicine, contains many peer-reviewed and full-text papers to help create enough information on their research topic and interest. Obtaining peer-reviewed research on any topic requires entering keywords relating to the issue into the database and filtering the results using the phrase “peer-reviewed.”

In every case, research analysis is a critical component of obtaining materials that address issues of interest to researchers. In this situation, the selected article demonstrates how nurses play an important role in assisting elderly patients with dementia and cognitive impairment. This study’s findings are reliable and valid, and they encourage practitioners to handle the issue in the most effective way possible to lessen the negative consequences of cognitive impairment on the elderly. More research can be conducted to improve the care given to older individuals.

Reference

Gibson, C., Goeman, D., & Pond, D. (2020). What is the role of the practice nurse in the care of people living with dementia, or cognitive impairment, and their support person(s)?: a systematic review. BMC Family Practice, 21(1). https://doi.org/10.1186/s12875-020-01177-y

Also Read: NURS 6003 PhinterMaurice Discussion Networking Opportunities

Case Analysis Patients Spiritual Needs Paper

Introduction

All human beings have a spiritual nature that is formed and developed based on their worldview. An individual’s spirituality is based on their faith (or lack thereof), stories of the origin of life, and their understanding of theology. Arguably, character and belief in spirituality is what shapes that which people value most in life. In the case of Mike and Joan, their faith in Christianity prompted them to cancel scheduled dialysis for their son James because they believed if they prayed hard, God would intervene and heal James. While patient autonomy is critical in making treatment decisions, in the case of children, the need to do what is in a child’s best interest overrides autonomy.

Question 1: Should the physician allow Mike to continue making decisions

Parents have the right to decide the kind of medical care their children should get. However, the act of refusing care for a child borders on neglect and child abuse. When it comes to a child’s medical health, irrespective of one’s faith, religion, and beliefs, the child’s medical attention supersedes any of these considerations (Anandarajah, 2005). Allowing Mike to continue making decisions for James based on his Christianity-informed worldview seems to be hurting the latter rather than helping him. It must be noted that Mike has the best intention for his son and hopes that his faith would lead to James’s healing.

Mike’s first decision to refuse dialysis for James resulted in permanent damage to the minor’s kidneys. The minor is now permanently on a dialysis machine and requires a kidney transplant for a year. The principle of fairness and justice advocates for nurses to air concerns on the patient’s treatment, the same should be expected of parents. Fairness and justice influence the treatment plans chosen for patients. Similarly, Mike and Joan should adopt the principle of fairness and justice in choosing an effective treatment plan for their son. In light of this analogy, it is critical that while Mike and Joan continue to pray for the healing of their son, they must allow the minor to get proper medical treatment to save his life. The fact that parents make all critical decisions for their children does not give them the right to infringe on their basic rights (Wiegand, 2015). Healthcare is a basic human right and must be accorded to all who need it. The refusal by Mike and his wife to take James for medical treatment is an infringement of this right. Apart from the constitutional right to healthcare, the principles of nonmaleficence and beneficence require people to do right and good to patients at all times, this includes making the right choices for intervention.

Q.2: How Should A Christian Think About Medical Intervention?

Many Christians around the world perceive sickness as spiritual warfare that require intervention through prayer. In the early church, the sick were brought to the church elders or priests to pray for them for healing. In contemporary Christianity, God is presented as the ultimate healer of all sicknesses/ailments (Doukas & Hanson, 2009). Thus, contemporary Christians believe that having faith in God and praying for the sick leads to healing. Even today, there are Christian denominations that forbid their followers from seeking medical help from healthcare facilities. However, the Bible does not expressly forbid Christians from seeking medical attention. In fact, the Bible quotes in Mark 2:17 that “On hearing this, Jesus said to them, “It is not healthy who need a doctor, but the sick. I have not come to call the righteous, but sinners” (New International Version). This statement by Jesus shows that not only did he recognize the importance of physicians but also validated their role in healing people using medical methods. Based on this narrative, it is incumbent upon Mike and Joan to practice nonmaleficence and beneficence by believing that God can heal their son through medical treatment.

Going by the principles of nonmaleficence and beneficence, Mike and Joan must do what is right for their son. These two principles state that nurses and other healthcare providers must, as a matter of ethics, execute their responsibilities in ways that do not cause any harm to patients. Likewise, these principles are not the preserve of nurses alone, all caregivers, parents, and all people who care for a sick person must exhibit the same principles by doing good and right by patients at all times (Reichman, 2005). If Mike and his wife observed these principles, the conflict between their faith and James’s medical attention would not arise. The right thing for James is to let him continue his dialysis treatment while Mike and Joan can continue praying for him to get well. There need not be a clash between religion and medicine; instead, the two critical components should complement each other. The Mikes can utilize their faith in God to help themselves and their son to cope with their stress and pain. In any case, numerous researches on spirituality and well-being show a strong connection between spirituality and wellbeing, which means that prayer contributes to well-being.

Q.3: How would a spiritual needs assessment help the physician assist Mike to determine appropriate interventions for James and for his family.

An assessment of the spiritual needs of Mike and his family by the physician is critical because it determines the final patient outcome. To begin with, the physician should assess what spirituality means for Mike and his family as far as the health of their son is concerned. The assessment is critical because it gives the doctor a chance to create an effective treatment plan that includes modern medicine and faith-based intervention (Timmins, & Caldeira, 2017). For example, James would continue with the dialysis program while the physician encourages prayer for the sick child. This two-pronged approach not only takes care of the spiritual needs of Mike’s family but also ensures that James is accorded the best medical treatment to save his life. Spirituality would give hope and strength to Mike’s family through this tough time.

Conclusion

Spirituality is a critical component of human life that shapes their worldview. Spirituality dictates how human live their lives which in turn defines what they indulge in or not. In this case study, Mike and Joan refuse to take their child, James, for dialysis, opting instead for prayers. James’s life takes a turn for the worse prompting Mike and his wife to reconsider dialysis to save James’s life. At this point, there is a clash between Mike’s belief in God and medicine as he believes that God can change James’s situation without medical intervention. The principle of fairness and justice advocates the need for healthcare providers to intervene appropriately on patient’s treatment, the same should be expected of parents. Through principles of nonmaleficence and beneficence, Mike and Joan must do what is right for their son, which is to accord him the appropriate medical intervention he needs.

References

• Anandarajah, G. (2005). Doing a Culturally Sensitive Spiritual Assessment: Recognizing Spiritual Themes and Using the HOPE Questions. AMA Journal Of Ethics, 7(5). doi: 10.1001/virtualmentor.2005.7.5.cprl1-0505
• Doukas & Hanson. (2009). The Penn Center guide to bioethics. Choice Reviews Online, 47(02), 47-0909-47-0909. doi: 10.5860/choice.47-0909
• Reichman, R. (2005). End of Life and Sanctity of Life, Commentary 1. Retrieved 26 March 2021, from http://journalofethics.ama-assn.org/2005/05/ccas2-0505.html
• Timmins, F., & Caldeira, S. (2017). Assessing the spiritual needs of patients. Nursing Standard, 31(29), 47-53. doi: 10.7748/ns.2017.e10312
• Wiegand, D. (2015). Palliative Care. Journal of Hospice & Palliative Nursing, 17(1), 7-13. doi: 10.1097/njh.0000000000000129

Case Study An Elderly Man With Slurred Speech and Left Side Weakness

A 60-year-old man is brought to the ER by ambulance because of slurred speech and left side weakness. His wife states they went to bed at 11pm and woke up at 5am when she noticed his symptoms. He is right handed with a history of coronary artery disease, hypertension, and hypercholesterolemia and a heart attack at age 50. He currently is unable to move his left arm and leg.

He had an episode of amaurosis fugux (blindness)in his right eye one month ago that lasted for 5 minutes. Around 3 months ago his wife states he had bilateral pain in his legs while they were on a walk that lasted about 15 minutes. He is taking a baby aspirin a day an ACE inhibitor, and statin as well. He does have a history of alcohol use and smoking in the past but stopped after his heart attack.

His blood pressure is 195/118 Pulse 106, Respiratory rate 18, Temperature 99.8, o2 sat is 97% on room air. Although his pupils are equal and reactive, and the ocular movements are intact, he is unable to turn his eyes voluntarily toward the left side.

The neck is supple, there is no jugular vein distension, and there are no bruits. The lungs are clear heart sounds regular without murmurs, and abdomen is normal. The limbs are not well perfused distally. The neurologic examination reveals that he is alert and oriented, although he does not recognize he is sick. He shows loss of awareness and attention with respect to objects or stimuli on his left sides.

He has mild dysarthria but, his speech is fluent, and he understands and follows commands very well. There is mild weakness on the left side of the face and left sided homonymous hemaianopsia, but there is no nystagmus or ptosis, and no tongue or uvula deviation. He is not able to move his left arm and leg, has hyperreflexia, and the left great toe is upgoing.

• What are two questions you would ask this patient?
• Identify the subjective data for this patient.
• Identify the objective data for this patient.
• What is the likely diagnosis?

Your response should include evidence of review of the course material, websites, and literature through proper citations using APA format.

Case Study 2 Overview

Mr. Hall, a 65-year-old male patient is admitted to the ICU through the ER with right-sided weakness and slurred speech. He has a hypertension & type 2 diabetes. He also reports a long history of smoking at least a pack of cigarettes each day. The CT scan from shows an intracranial hemorrhage.

In this discussion:

1. What is the most likely cause of the hemorrhagic stroke?
2. Describe the risk factors for both hemorrhagic & ischemic stroke.
3. Discuss the most likely area of the brain affected by the stroke.
4. Discuss this patient’s short and long-term plan of care & prognosis.

Include citations from the text, the Shadow Health simulation assignment, and/or the external literature in your discussion posts

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Gradin Criteria

Case Study 2: Mr. Hall Sample Solution

The case study concerns Mr. Hall, a 65-year-old male who was moved from the emergency room (ER) to the intensive care unit (ICU) with right-sided weakness and slurred speech. He is a known hypertensive patient, has type 2 diabetes mellitus, and long-standing history of tobacco use. The CT scan investigation revealed intracranial hemorrhage.

Cause of his Stroke

Mr. Hall has a hemorrhagic stroke that could be from different causes. However, his hypertension is the most likely cause of his hemorrhagic stroke. Persistently high blood pressure can rupture the small vasculature of the brain leading to a hemorrhage that occupies space in the fixed skull space to cause the focal symptom Case Study: An Elderly Man With Slurred Speech and Left Side Weakness. Paradoxically, hypertension treatment can also lead to ischemic stroke when the management is overzealous enough to reduce the blood pressure to levels causing hypoperfusion. This phenomenon is rare but occurs more in elderly patients.

Risk Factors for Stroke

Both hemorrhagic and ischemic stroke can be caused by hypertension, among other risk factors. The most common risk factors for hemorrhagic stroke include but are not limited to poorly controlled hypertension (Kuriakose & Xiao, 2020), coagulopathies with bleeding tendencies, vascular malformations, and angiopathies Case Study: An Elderly Man With Slurred Speech and Left Side Weakness. These causes increase the risk of bleeding in the brain leading to stroke. The bleeding can be acute or long-standing, depending on the cause.

Ischemic stroke common risk factors include but are not limited to familial predisposition, hypertension, cardiac disease including atrial fibrillation, hyperlipidemia, diabetes mellitus, alcohol use, and smoking (Kuriakose & Xiao, 2020). These causes increase the risk of reduction or occlusion of blood supply to certain brain regions leading to ischemic stroke Case Study: An Elderly Man With Slurred Speech and Left Side Weakness. Mr. Hall has three risks for ischemic stroke and only two for hemorrhagic stroke: smoking, diabetes mellitus, and hypertension a long history of smoking and hypertension and smoking for hemorrhagic stroke.

Brain Areas Affected By Stroke

Stroke can affect many areas of the brain, but the major areas include but are not limited to the frontal lobe, parietal lobes, basal ganglia, and brain stem. However, the area affected is determined by the artery affected by ischemia or hemorrhage. The most common vessel is the middle cerebral artery (Hui et al., 2021), making the frontal lobe, temporal lobe, basal ganglia, and internal capsule the most common areas in cases of infarction.

Cerebellar stroke is also not uncommon. Mr. Hall has slurred speech and right-sided weakness, suggesting that the left temporal lobe was the most likely affected area of the brain. The Wernicke’s area is located in the temporal cortex and is responsible for speech-motor coordination. Notably, Wernicke’s area is not the only area in the speech pathway.

Mr. Hall’s Management and Prognosis

The management goals for Mr. Hall are promoting repairs and preventing the deterioration of his status. In the short term, blood pressure reduction and prevention of pressure symptoms, including seizures, are prioritized Case Study: An Elderly Man With Slurred Speech and Left Side Weakness. Therefore, antihypertension medications, anticonvulsants, and diuretics to relieve intracranial pressure would be used (Wajngarten & Silva, 2019).

Thrombolysis may worsen the bleeding. In the long term, the aim is to help Mr. Hall regain his cognitive, motor, and speech function will be important. Physiotherapy, speech therapy, and occupational therapy will be offered to improve his prognosis. Risk prevention will include hypertension management, teaching on smoking cessation, and regular sugar controls for Mr. Hall.

Conclusion

Mr. Hall had a hemorrhagic stroke, most likely in the left temporal cortex. The known risk factors for his stroke are hypertension and longstanding smoking. His shirt term management will include the use of antihypertensives, anticonvulsants, and diuretics Case Study: An Elderly Man With Slurred Speech and Left Side Weakness. However, the long-term will be rehabilitative and restorative. Physical, speech and occupational therapies will be prescribed. Prevention of his risk factors will also be prioritized for a better long-term prognosis.

Case Study An Elderly Man With Slurred Speech and Left Side Weakness References

• Hui, C., Tadi, P., & Patti, L. (2021). Ischemic Stroke. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499997/
• Kuriakose, D., & Xiao, Z. (2020). Pathophysiology and treatment of stroke: Present status and future perspectives. International Journal of Molecular Sciences, 21(20). https://doi.org/10.3390/ijms21207609
• Wajngarten, M., & Silva, G. S. (2019). Hypertension and stroke: Update on treatment. European Cardiology, 14(2), 111–115. https://doi.org/10.15420/ecr.2019.11.1

Ischemic Heart Disease Discussion Sample Paper

Question One

The risk factors present in this case include advanced age (58 years), male gender, and elevated blood pressure 122/74. Male gender and advanced age the non-modifiable risk factors for angina (Kloner & Chaitman, 2017) while elevated blood pressure is modifiable. However, if not checked, Bill’s blood pressure may progress to hypertension which could be fatal.

Question Two

The goals for treatment include increasing oxygen supply to the heart and reducing the oxygen demands of the myocardium (Kloner & Chaitman, 2017). Pains due to angina occur when the oxygen demands exceed supply. An approach to reduce heart rate, preload, and afterload and improve coronary blood flow would relieve the symptoms.

Question Three

I recommend an organic nitrate like nitroglycerin to Bill to prevent the occurrence of angina attacks. Nitroglycerin is a vasodilator (Soman & Vijayaraghavan 2017) that works by dilating the coronary blood vessels leading to an increase in blood supply to the heart.

Question Four

For acute episodes of angina, aspirin, clopidogrel or heparin would be effective. The drugs are anticoagulants. They prevent clot formation in coronary blood vessels improving blood flow to the heart. Due to increased heart perfusion, there will be decreased pains.

Question Five

Beta-blockers decrease cardiovascular mortality since they reduce the chances of myocardial infarction and are beneficial when cardiac infarction has not occurred (Kloner & Chaitman, 2017). I will recommend them for additional medical outcomes. They include atenolol and metoprolol.

Question Six

The drug therapy monitoring plan in the case of Bill would aim at determining the possible toxicity of the medications and whether the problem resolves. The drug therapy monitoring will take place after every 24 hours for two weeks. Optimal therapy improves angina symptoms within two weeks. The monitoring will include measuring the blood pressure, checking for signs of dizziness, headache, peripheral edema, and constipation when calcium channel blockers are used. A report on pain resolution would be necessary to determine the effectiveness of the medications.

Question Seven

Patient education includes explaining the causes of angina, the diagnosis, and prevention measures. The approach would include advising Bill on the importance of physical activity, not smoking, and the importance of screening for diabetes and hypertension regularly. Drug adherence and the ways to take them would also be part of the plan.

References

• Kloner, R., & Chaitman, B. (2017). Angina and Its Management. Journal Of Cardiovascular Pharmacology And Therapeutics, 22(3), 199-209. https://doi.org/10.1177/1074248416679733
• Soman, B., & Vijayaraghavan, G. (2017). The role of organic nitrates in the optimal medical management of angina. E-Journal of Cardiology Practice, 15(2). https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15

Case Study Death and Dying Sample Paper

Introduction

From the case study provided, George is suffering from a degenerative disorder ASL- Amyotrophic Lateral Sclerosis in which he has only 3-4 years to live. George is fully aware of the debilitating state that he is going to be in when the disease fully settles in. For example, George risks losing his ability to speak, move, eat, and breathe. George fears the prospect of being fully dependent on other people to perform even basic chores like cleaning himself. He is contemplating voluntary euthanasia to cut his life short before his condition degenerates into a vegetative state.

Voluntary termination of a patient’s life through euthanasia is a very controversial issue. In particular, the Christian worldview on the termination of life holds strongly that no person has the right to terminate another person’s life or even one’s own life. While some people feel it is fine to relieve suffering patients from pain by terminating their lives, others feel that this is wrong based on moral and ethical principles.

Nurses are entitled to their beliefs, morals, and values which may be different from those of their patients. Giving care to patients who are close to the end of their lives is a difficult process, not just physically, but also emotionally and psychologically (Meller et al, 2018). Yet, nurses sometimes witness complicated scenarios where families of such patients must make difficult choices to end the lives of their loved ones.

Another ethical dilemma in health care ethics is the issue of physician initiatives. Physicians may sometimes be called upon to make difficult decisions to end a patient’s life through requests (Khalaf et al, 2017). This can be done using euthanasia or the physician-assisted suicide method. While there is a lack of consensus regarding how unethical or ethical these issues are, the dominant argument tends to hinge on an individual’s right to live. Some people feel it is unethical for physicians to end a patient’s life while others feel it is okay to relieve suffering patients of their pain by terminating their lives.

How George would interpret his suffering in light of the Christian Narrative

Christian worldview of chronic death is the response to a disparity that people display or exhibit when a significant loss occurs. Chronic death is a term used to describe the state of sadness that patients get into when dealing with pain from their health conditions. The Christian worldview of death provides an approach that can be used to understand the problem of chronic death. This approach encompasses parameters such as antecedents, external management methods, internal management methods, and trigger events. The importance of this theory is that it helps in analyzing responses from individuals who are experiencing disparate emotions arising from bereavement, chronic illness, and caregiving responsibilities. Christian worldview of death enables nurses and other caregivers to understand that death is a normal occurrence and that individuals experiencing such loss need access to positive coping strategies.

How would George interpret his suffering in light of the Christian narrative, with an emphasis on the hope of resurrection?

Christian worldview of death states that Christians must live a righteous life on earth with the hope of resurrecting during end times. In the past, death was associated with the grief in parents/caregivers of children suffering from chronic health issues. Today, the term has been expanded to mean normal response to grief associated with a painful loss such as death. Chronic sorrow is also known as living loss because it stays with the grieving person for an extended period of time (Buckley & Stricklin, 2017). In many cases, a medical crisis capable of magnifying the disparity between the existing reality and the life hoped for results in the possibility of a return of the sadness.

Confusion, anger, and frustration are some of the emotions exhibited by people who know their lives will be cut short by disease. The concept of death comes out clearly in bereavement and other types of significant losses even though people may sometimes question some responses of death by grieving people. For instance, when a bereaved person suddenly shows strong emotions of anger and behaves out of character, healthcare professionals may deem the behavior as unbecoming or inappropriate (Tofthagen, et al., 2017). Many healthcare professionals have no proper understanding of chronic death hence are not able to deal with it when it is exhibited by a grieving person.

In Chapter 4, the healthcare professionals in the scene are aware of the loss the angry man with the gun is going through, however, they do believe that his reaction is inappropriate. Offering counseling services to caregivers of patients early before any tragic event happens can help grieving people to quickly adjust to reality when the tragic event does occur (Funk, Peters, & Roger, 2017). For example, the reaction witnessed in the old man after the loss of his wife may not have been witnessed if he had received professional counseling early, especially when it became apparent that he may lose his wife.

How George would contemplates life with ALS. How would the Christian worldview inform his view about the value of his life as a person

           In Practice, knowledge or the understanding of chronic sorrow aid health practitioners in creating effective coping mechanisms for themselves and grieving clients/customers. Having a good background and understanding of the concept can help such professionals to learn and inculcate in their systems an effective and therapeutic communication that they can use to help grieving people deal with their pain (Jinks, 2018).

For example, in the clip provided, all the healthcare professionals in the scene are some of the best physicians at the hospital and can handle even the most complicated medical operations; however, none of them seem to understand how to deal with the issue of chronic death in grieving persons. Having effective and therapeutic communication skills would have helped to diffuse the tension witnessed in this scene. However, what comes out is a picture of confusion, anger, and frustration which should not have been the case especially with the professionals in the room.

An understanding of chronic sorrow can help to improve the quality of care given by community health nurses. Community health nurses interact closely with patients under their care which means they occasionally witness scenes of death and anger. Their understanding of the theory of death can help them to prepare their grieving customers/clients/patients to deal with the associated emotions. Further, as Oates and Maani-Fogelman (2019) observe, such experienced nurses can prepare their patients and patient relatives on how to effectively cope with tragic events such as death when it occurs. An understanding of the theory by this group of professionals is essential in a healthcare environment because it enables the practitioners to lessen and contain irrational behavior in grieving persons by offering guidance and counseling adequately early before any tragic event occurs.

In terms of research, extensive literature is available on parents or caregivers dealing with children with physical disabilities or children with mental retardation problems. Contemporary researchers have sought to widen the scope of chronic death to include persons who are bereaved from the death of close relatives, friends, and family. One of the outstanding studies that has contributed widely to the understanding of the theory is the research done by Damrosch and Perry in 1989. The duo conducted a small study that compared parents in families with children with Down’s syndrome (Coughlin, & Sethares, 2017). The study evaluated the parents on pertinent issues such as exhibiting chronic death, patterns of adjustment, and coping mechanisms. The findings from the study revealed valuable results especially on coping which has led to better understanding of the theory of death.

What sorts of values and considerations would the Christian worldview focus on in deliberating about whether or not George should opt for euthanasia?

From the Christian worldview, and given the kind of values upheld in Christianity, the focus should be on whether opting for euthanasia is the best decision for George. Further, these values should include the appreciation of suffering as part of an individual’s life on earth, which is also a reflection of Jesus’ suffering. Just as the Bible teaches that Jesus; suffering was God’s desire, so should we be able to interpret George’s suffering as God’s plan for him. Furthermore, it is important to understand that Christian teachings define suffering as God’s tool of bringing humanity closer to him. He can therefore use this time to evaluate God’s desires for him and to work on getting closer to God. That said, much research work concerning the justification for euthanasia reveals a positive relationship between parameters such as the optimistic definition of circumstances, maintaining family integration, social support, and positive self-esteem with positive outcomes. These elements should help inform the decision of whether a patient should opt for euthanasia.

What options would be morally justified in the Christian worldview for George and why?

           George’s understanding and knowledge of chronic pain is critical as it prepares him to cope with the inevitable. Instead of deep feelings of sadness, and anger, the knowledge of chronic sorrow can help George to adopt positive strategies of dealing with the condition and continuing with treatment therapy. In terms of a Christian worldview, the only option George has is to accept his condition and continue having faith in God that all will be well. However, for George, death is inevitable and as a Christian, he should be ready to wait until natural death does occur. The use of Euthanasia as a method of mercy killing is expressly abolished in the Bible under the doctrine ‘thou shall not kill’. This doctrine refers to the killing of other people or killing oneself.

Christian worldview of chronic death can help nurses and doctors to identify the symptoms of death and deal with it early. Symptoms of grief often start before death occurs and continues after it has occurred. In the video scene provided, it is apparent that the angry man whose wife has just died had been experiencing pain and death even before his wife died. Having knowledge of death by nurses and doctors at the hospital would have helped to avert the current crisis. The knowledge would have helped them to provide therapy and other coping strategies to the man way before he was bereaved.

Based on your worldview, what decision would you make if you were in George’s situation?

As a Christian, the phenomenon of mercy killing is not an option. If I were in George’s shoes, I would continue taking medication, especially medication for pain so that I am not in much pain. After controlling the pain, I would patiently wait for the day that my natural death occurs. I believe my loved ones would willingly take care of me until death occurs. It is incumbent on the relatives of a sick person to care for their loved one until their demise. In my culture, it is allowed for family members to hire professional caregivers to help them in taking care of sick relatives. This can ease the pressure of taking care of a sick person.

Cooperation with active suicide and euthanasia is one of the issues covered in chapter seven of the book. Termination of the lives of patients using euthanasia is a very controversial issue. While some people feel it is fine to relieve suffering patients from pain by terminating their lives, others feel that this is wrong based on moral and ethical principles. Nurses are entitled to their beliefs, morals, and values which may be different from those of their patients.

Giving care to patients who are close to the end of their lives is a difficult process, not just physically, but also emotionally and psychologically (Zheng, Lee, & Bloomer, 2017). Nurses may sometimes witness complicated scenarios where families of such patients must make difficult choices to end the lives of their loved ones. There is a lack of consensus regarding how unethical or ethical these issues are. Some people feel it is unethical for physicians to end a patient’s life while others feel it is okay to relieve suffering patients of their pain by terminating their lives.

Conclusion

When people face imminent death, the situation causes immense emotional and psychological trauma. George is aware that in 3-4 years, his life will be cut short by ASL- Amyotrophic Lateral Sclerosis. Being a degenerative disease, George is afraid of the debilitating state he will be in three years’ time and contemplates voluntary suicide through euthanasia. the Christian worldview on the termination of life holds strongly that no person has the right to terminate another person’s life or even one’s own life. While some people feel it is fine to relieve suffering patients from pain by terminating their lives, others feel that this is wrong based on moral and ethical principles. The contentions notwithstanding, if I were in George’s shoes I would choose to persevere the pain till the end of time as opposed to choosing euthanasia.

References

• Buckley, C. J. L., & Stricklin, S. M. (2017). When Sorrow Never Stops. Journal of Christian Nursing, 33(1), 22-29. 10.1097/cnj.0000000000000231.
• Coughlin, M., & Sethares, K. (2017). Chronic Sorrow in Parents of Children with a Chronic Illness or Disability: An Integrative Literature Review. Journal Of Pediatric Nursing, 37, 108-116. https://doi.org/10.1016/j.pedn.2017.06.011
• Funk, L. M., Peters, S., & Roger, K. S. (2017). The Emotional Labor of Personal Grief in Palliative Care: Balancing Caring and Professional Identities. Qualitative Health Research, 27(14), 2211–2221. doi: https://doi.org/10.1177/1049732317729139
• Jinks, A. M. (2018). Conclusions drawn from the literature review and the research questions. Caring for Patients, Caring for Student Nurses, 42–45. doi: 10.4324/9780429459610-4
• Khalaf, I. A., Al-Dweik, G., Abu-Snieneh, H., Al-Daken, L., Musallam, R. M., Baniyounis, M., Masadeh, A. (2017). Nurses’ Experiences of Grief Following Patient Death: A Qualitative Approach. Journal of Holistic Nursing, 36(3), 228–240. doi: 10.1177/0898010117720341
• Meller, N., Parker, D., Hatcher, D., & Sheehan, A. (2019). Grief experiences of nurses after the death of an adult patient in an acute hospital setting: An integrative review of literature. Collegian, 26(2), 302–310. doi: 10.1016/j.colegn.2018.07.011
• Oates, J. R., & Maani-Fogelman, P. A. (2019). Nursing Grief and Loss. In StatPearls. StatPearls Publishing.
• Tofthagen, C., Kip, K., Witt, A., & Mcmillan, S. (2017). Complicated Grief: Risk Factors, Interventions, and Resources for Oncology Nurses. Clinical Journal of Oncology Nursing, 21(3), 331–337. doi: 10.1188/17.cjon.331-337
• Zheng, R., Lee, S. F., & Bloomer, M. J. (2017). How nurses cope with patient death: A systematic review and qualitative meta-synthesis. Journal of Clinical Nursing, 27(1-2). doi: 10.1111/jocn.13975

Case Study: Contraception Options

Case Study: Contraception Options Scenario 1

Elaine Goodwin is a 38-year-old G5 P5 LC 6?presenting to your clinic today to discuss contraceptive options.??She states that she is not interested in having more children?but her new partner has never fathered a child.?Her medical history is?remarkable for exercise-induced asthma, migraines, and IBS.?Her surgical history?is remarkable only for tonsils as a child. Case Study: Contraception Options

Her social history is negative for?alcohol, tobacco, and recreational drugs.? She has no known drug allergies and takes only vitamin C.?Hospitalizations were only for childbirth.?Family history?reveals that her maternal grandmother is alive with dementia, while her maternal grandfather is alive with COPD. Her paternal grandparents are both deceased?due to an automobile accident.

Her mother is alive with osteopenia and fibromyalgia, and her dad is alive with a history of skin cancer (basal cell).?Elaine has one older sister with no medical problems and one younger brother with no reported medical problems Case Study: Contraception Options.

ORDER COMPREHENSIVE SOLUTION PAPERS ON Case Study: Contraception Options

• Height 5’ 7”?Weight?148?(BMI 23.1),?BP 118/72 P?68
• HEENT:? wnl
• Neck: supple without adenopathy
• Lungs/CV: wnl
• Breast: soft, fibrocystic changes bilaterally,?without masses, dimpling or discharge
• Abd: soft, +BS, no tenderness
• VVBSU: wnl, except?1st?degree cystocele
• Cervix: firm, smooth, parous, without CMT
• Uterus: RV, mobile,?non-tender,?approximately 10 cm,
• Adnexa: without masses or tenderness

QUESTION:

What other information do you need?

MORE QUESTIONS:

1. What has she used in the?past?? Why did she stop a?method?? How many partners in past 12?months?
2. What are her current cycles like?
3. When was her last gyn exam?and what were the results of?the?tests?
4. Are her migraines with or without auras?
5. What method has she considered.

QUESTIONS:

•What are your next steps/considerations?

•;What teaching should you do?

•What methods are appropriate for Elaine?

NRNP 6552: Advanced Nurse Practice in Reproductive Health Care

Episodic/Focused SOAP Note Template

Patient Information:

Initials, Age, Sex, Race

S.

CC (chief complaint): This is a brief statement identifying why the patient is here in the patient’s own words, for instance, “headache,” not “bad headache for 3 days.” Case Study: Contraception Options

HPI: This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. Use LOCATES Mnemonic to complete your HPI. You need to start every HPI with age, race, and gender (e.g., 34-year-old African American male). You must include the seven attributes of each principal symptom in paragraph form, not a list. If the CC was “headache,” the LOCATES for the HPI might look like the following example:

Location: head

Onset: 3 days ago

Character: pounding, pressure around the eyes and temples

Associated signs and symptoms: nausea, vomiting, photophobia, phonophobia

Timing: after being on the computer all day at work

Exacerbating/relieving factors: light bothers eyes, Naproxen makes it tolerable but not completely better

Severity: 7/10 pain scale

Current Medications: Include dosage, frequency, length of time used, and reason for use. Also include over-the-counter (OTC) or homeopathic products.

Allergies: Include medication, food, and environmental allergies separately. Provide a description of what the allergy is (e.g., angioedema, anaphylaxis). This will help determine a true reaction versus intolerance.

PMHx: Include immunization status (note date of last tetanus for all adults), past major illnesses, and surgeries. Depending on the CC, more info is sometimes needed. Soc & Substance Hx: Include occupation and major hobbies, family status, tobacco and alcohol use (previous and current use), and any other pertinent data. Case Study: Contraception Options

Always add some health promotion questions here, such as whether they use seat belts all the time or whether they have working smoke detectors in the house, the condition of the living environment, text/cell phone use while driving, and support systems available.

Fam Hx: Illnesses with possible genetic predisposition, contagious illnesses, or chronic illnesses. The reason for death of any deceased first-degree relatives should be included. Include parents, grandparents, siblings, and children. Include grandchildren if pertinent. Case Study: Contraception Options

Surgical Hx: Prior surgical procedures.

Mental Hx: Diagnosis and treatment. Current concerns: (Anxiety and/or depression). History of self-harm practices and/or suicidal or homicidal ideation.

Violence Hx: Concern or issues about safety (personal, home, community, sexual—current and historical).

Reproductive Hx: Menstrual history (date of last menstrual period [LMP]), pregnant (yes or no), nursing/lactating (yes or no), contraceptive use (method used), types of intercourse (oral, anal, vaginal, other), and any sexual concerns. Case Study: Contraception Options

ROS: This covers all body systems that may help you include or rule out a differential diagnosis. You should list each system as follows: General: Head: EENT: and so forth. You should list these in bullet format and document the systems in order from head to toe.

Example of Complete ROS:

GENERAL: No weight loss, fever, chills, weakness, or fatigue.

HEENT: Eyes: No visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.

SKIN: No rash or itching.

CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No palpitations or edema.

RESPIRATORY: No shortness of breath, cough, or sputum.

GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood.

GENITOURINARY: Burning on urination. Pregnancy. LMP: MM/DD/YYYY.

NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.

MUSCULOSKELETAL: No muscle pain, back pain, joint pain, or stiffness.

HEMATOLOGIC: No anemia, bleeding, or bruising.

LYMPHATICS: No enlarged nodes. No history of splenectomy.

PSYCHIATRIC: No history of depression or anxiety.

ENDOCRINOLOGIC: No reports of sweating or cold or heat intolerance. No polyuria or polydipsia.

REPRODUCTIVE: Not pregnant and no recent pregnancy. No reports of vaginal or penile discharge. Not sexually active.

ALLERGIES: No history of asthma, hives, eczema, or rhinitis.

O.

Physical exam: From head to toe, include what you see, hear, and feel when conducting your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and history. Do not use “WNL” or “normal.” You must describe what you see. Always document in head-to-toe format (i.e., General: Head: EENT:) Case Study: Contraception Options

Diagnostic results: Include any labs, x-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines).

A.

Differential Diagnoses (list a minimum of 3 differential diagnoses). Your primary or presumptive diagnosis should be at the top of the list. For each diagnosis, provide supportive documentation with evidence-based guidelines. Case Study: Contraception Options

P.

Includes documentation of diagnostic studies that will be obtained, referrals to other health care providers, therapeutic interventions, education, disposition of the patient, and any planned follow-up visits. Each diagnosis or condition documented in the assessment should be addressed in the plan. The details of the plan should follow an orderly manner. Also included in this section is the reflection. The student should reflect on this case and discuss whether or not they agree with their preceptor’s treatment of the patient and why or why not. What did they learn from this case? What would they do differently?

Also include in your reflection a discussion related to health promotion and disease prevention, taking into consideration patient factors (e.g., age, ethnic group), PMH, and other risk factors (e.g., socioeconomic, cultural background). Case Study: Contraception Options

Case Study: Contraception Options References

You are required to include at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting. Case Study: Contraception Options